(Thanks to my friend Huang Jin for his encouragement)

Today's Liu Banxia can be described as high-spirited, because he also needs to fight for his career. This career is not only about solid medical skills, but also about the management ability and position in the hospital.

In terms of money, he can't compare to Qiaoqiao, only solid medical skills and positions can make him a little higher. This is also a helpless thing, and it is also a complication of finding a rich girlfriend.

You can't really ignore these things, you can treat money as dung, and now Liu Banxia also hopes that this dung can come more.

"Mr. Liu, do you have time now? Liu Banxia was still thinking about it, and Zhang Xiao, who was outside the gods, called out to him.

"Okay, come here, what's the situation?" Liu Banxia ran over.

He has to be on call for this matter, and whoever makes him be hospitalized always comes. Moreover, it is also a special location of the hospitalization total, which must be fully involved.

"Ah, the boss and Brother Xu are also there, why don't I know about such a serious case?" Seeing that Shi Lei and Xu Hui were also there, he was shocked.

"As soon as I got off the stage, the situation is a little complicated. Shi Lei said.

"The car accident patient who came in the morning while you were away had cardiac arrest at the time of treatment. And when we found that the pupil response was not good during the physical examination, we called Dr. Zhang over and went to the stage to do the surgery together. ”

"At present, the spleen is removed and the external ventricular drainage is done to reduce the intracranial pressure, and the latest CT results show that the patient has no bleeding, but has edema. ”

"The patient is in our ICU ward, but the intracranial pressure is slowly rising. So at present, we are a little entangled, whether to continue to do bone flap decompression, or continue to control it through internal medicine means. ”

"What makes us difficult to decide now is that the patient's latest blood test results show a very low platelet count, which increases the risk of surgery a lot. ”

Liu Banxia frowned, this matter is really not so easy to decide.

Because the main function and function of platelets is to stop bleeding and coagulation, if the platelet count is very low, then how to do surgery?

However, for this patient's current situation, if surgery is not performed to lower the cranial pressure, the increasing cranial pressure will also kill him.

"Brother Zhang, how long is it expected that edema will cause damage to the brain?" asked Liu Banxia.

"We don't have too much time, five or six hours at most. Zhang Xiao said.

"And brain damage is just a broad term, and any brain edema that compresses the brain tissue can cause damage. ”

"In other words, we don't have a lot of time left, and I don't know if I can ask the patient's family for advice and take the risk. What I'm worried about is that the damage is irreversible, otherwise even if I am saved, my life will be over. ”

"Yes, that's the most sorrowful of all. But his platelet index was really low, and I thought he might be anemic in another hour or two. Xu Hui said.

"We gave him a lot of plasma, packed red blood cells, and platelets during and after the operation, can we make his body recover temporarily through a drug coma, after all, he has just undergone surgery and has not recovered from the operation. ”

"And such control? How much can I reduce some intracranial pressure? Can it buy us more time? At least we can find out what causes thrombocytopenia. ”

Zhang Xiao nodded, "I also agree with this?" But do we want to set a time node? You can't wait indefinitely. At that time, brain herniation will form, and if you don't do it well, you will become a vegetative person or die. ”

"Boss? What do you think?" Liu Banxia looked at Shi Lei.

Shi Lei shook his head, "The situation is too complicated?" We don't have a lot of time left. Does it take time to find out the cause? However, the patient's intracranial pressure does not give us so much time. ”

"Well, first of all, it's important to explain everything to the patient's family, so that they can have a comprehensive understanding. What medical advice can we give? Is it the first drug-induced coma? Improve the patient's vital signs. Liu Banxia said.

"At the same time, let's think about what causes the patient's thrombocytopenia, and after finding out, we can give a detailed medical plan. ”

"Brother Zhang has to work harder, and he has to pay attention to the intracranial pressure of this patient at any time. At the time node, let's set a blood test in an hour and a half to see how it goes? And then how about discussing it?"

"Conservative treatment, although not so safe, is at least one of the feasible solutions that we can think of now. If the patient's platelet index cannot be raised? It is really possible that you will not be able to clot blood during the operation and will not be able to get off the stage. ”

"Okay? Rest assured, I will always pay attention to the patient's intracranial pressure. This patient is currently one of the more serious patients in the ICU ward? There's also a lot of attention over there. Zhang Xiao nodded.

"Mr. Liu? Do you need to use your brain? I thought about it for a long time, but I didn't figure it out for the time being. Xu Hui said with a wry smile.

Liu Banxia also grinned, but he didn't expect Xu Hui to put the treasure on himself. Maybe it's also because your performance during this period of time is too dazzling?

"Well, you must have been discussing it for a long time just now, and your brains are all messed up. Let's consider each of them now based on the existing diagnosis. When we meet again after the next blood test results come out, we may have a clear idea. Liu Banxia said.

The three of them nodded in unison, and they could only choose this way at present.

"Boss, did Xu Hui and Zhang Xiao get up just now?" Liu Banxia asked in a low voice after he came out.

Shi Lei nodded, "Otherwise, I wouldn't have proposed to let Zhang Xiao call you, and at present, only you and the director can play a coordinating role, so I can't go to the director, right?"

"Hey...... , It's normal to have arguments, and it won't affect future cooperation, right?" Liu Banxia asked worriedly.

"Don't worry, this professionalism will still be there. It's normal for you to have disagreements about the direction of diagnosis in cases, haven't you done it before? Shi Lei said.

"But this matter is really to be rushed, otherwise this patient will be really dangerous. I'll go and talk to my family first, after all, I'm a neutral party, and it's not appropriate for either of them to go. ”

Liu Banxia nodded, and he was also a little anxious in his heart.

They are all understanding people, and being able to make Zhang Xiao and Xu Hui have a dispute proves that the current situation of patients is really too complicated and too acute.

It can even be said that his decision just now is also a risk, just like Zhang Xiao said, the impact of intracranial pressure on the brain can only be not accurately predicted.

In principle, it is all about dealing with it as soon as possible.

"Mr. Liu, what's wrong?" Wang Chao asked curiously.

"Thinking about a case, the patient had thrombocytopenia and increased intracranial pressure, which was the car accident patient Shi Lei and they treated when I went to the orthopedic department. Liu Banxia said.

"When a patient comes here again, don't call me if it's not an emergency or a big accident, I have to think about this patient. ”

Wang Chao nodded, "No wonder they got together after the operation, I only knew that they were sent to the ICU, but I didn't expect it to be so serious." ”

"So I have a bit of a headache, so I'll look at it first. Liu Banxia dropped a sentence and went into his office.

There are really too many possible factors that cause thrombocytopenia, and the most common ones are platelet production disorders, such as aplastic anemia, acute leukemia, acute radiation sickness, etc.

Then there is increased platelet destruction, such as primary thrombocytopenic purpura, hypersplenism, diffuse intravascular coagulation, familial thrombocytopenia, etc.

If you want to find out the cause, you have to try little by little. But these attempts are not so simple, it doesn't mean that you do a blood test on the patient, and everything can be seen at a glance.

More often than not, blood tests only see results, and then doctors need to work backwards based on what they have learned to find the cause of this result.

Combined with the current known factors, it is possible to rule out some diseases, such as hypersplenism, and the spleen has been removed. There are also diseases like familial thrombocytopenia, but there are many other factors.

His main suspicion now is diffuse intravascular coagulation, and major surgery or trauma is one of the underlying conditions that can lead to this complication.

It is likely that the car accident and the surgery that had just been performed caused the patient's diffuse intravascular coagulation, resulting in a low platelet count.

However, it is not uncommon to have some inconsistencies with this disease, that is, in the cases provided by the ICU, no bleeding from the wound was found.

Bleeding is one of the most fundamental manifestations of the disease during the onset of the disease.

The patient's platelet count was a little low, but it was not exaggerated. And it should still be slowly reduced, and the patient's current blood test report has normal coagulation function.

The key to the problem is time, if the patient has so much time, it can be investigated little by little by technical means. However, the intracranial pressure of the patient is constantly increasing, which can cause brain damage to the patient.

After pondering in the office for a while, Liu Banxia slapped his head, and then ran out like the wind.

"I was looking for you, the opinion of the patient's family is to do decompression surgery as soon as possible?" Shi Lei, who came over, said anxiously.

"Boss, do you think it will be thrombotic thrombocytopenic purpura?" Liu Banxia said.

"You mean TTP, is it possible?" Shi Lei asked rhetorically with a frown.

"It may be impossible, let's go directly to the ICU and call Xu Hui and Zhang Xiao as well. Liu Banxia said.

"If that's the case, if you have surgery, you will definitely die. We can't delay now, so let's go over and have a look. ”

Although Shi Lei was still a little unsure, he also nodded. After all, there must be some basis for Liu Banxia to say it.